Summary

• Over 7 years of Experience as a Business System Analyst in Healthcare and Insurance domain with solid understanding of Business Requirements Gathering, Evaluating Data Sources, Business Process Flow, Business Process Modeling, translating Requirements into Specifications, EDI and Application Design.
• Experience in all phases of the Software Development Life Cycle SDLC including Requirement gathering, in depth Analysis, Data Analysis
• Experience writing Use Cases and Functional Requirement Documents
• Experience preparing Test Scenarios, Test Cases in HP Quality Center
• Excellent knowledge of Health Claim forms like UB04 and HCFA 1500
• Hands on experience with Business functionalities like Medicare, Medicaid, Commercial claims, Insurance specific trends.
• Skilled in Interviews, Joint Application Development Sessions JAD , Focus sessions for requirements gathering, analysis and design with stakeholders, SME's, Developers and system architects.
• Experience with Healthcare systems, HIPAA compliance applications and electronic exchange guidelines including 850,856,810 210 EDI documents
• Experience with Medicare, Medicaid and commercial insurances in HIPAA ANSI X12 formats including 270/271, 835, 837, 997
• Experience with claims process and adjudication in the Medicare, Medicaid Private Insurance Sectors
• Well Versed on HIPAA regulations and requirements
• Knowledge of HIPAA 4010 and 5010 EDI transactions..
• Detail understanding of ICD 9/ANSI/HL7 to ICD 10/ANSI/HL7 coding standards in Medicare and Medicaid domains of the healthcare industry.
• Interfaced with business users to create Business Requirements Document and Functional Specifications Document based on the analysis of HIPAA transaction processing workflow model.
• Extensive knowledge of CPT, ICD9 ICD 10 CM, HL7, HIX.
• Knowledgeable in the retention and data management of electronic medical records to meet legal and clinical requirements, and in the privacy and policy issues surrounding electronic medical records management and access.
• Extremely knowledgeable with regard to Medical Coding Guidelines and coding techniques.
• Proficient in physician coding, inpatient hospital coding, outpatient coding, facility coding and home health coding.
• Good working knowledge of Medicare, Medicaid, Tricare, Workers Comp and Commercial Insurance

TECHNICAL SKILLS:

PROFFESIONAL EXPERIENCE:

Confidential

Sr. Business Systems Analyst

Responsibilities:

• Participate in all Iteration, Scrum, Daily stand-ups and Iteration review meetings working in an agile development methodology.
• Lead JAD sessions with subject matter experts SMEs from each work stream/business unit for particular correspondence lifecycles, process flows, and triggering conditions etc. for development within the environment translate business requirements into a functional document and solution design.
• Prepared the BRD, FRD and conducted reviews with the stake holders.
• Leading Sprint Planning meetings, getting estimates from individuals BA's and assigning tasks based on velocity/capacity.
• Create data mapping documentation including standardizing and validating data tags, creating data dictionaries for new and existing correspondences and reports for the purposes of data analysis.
• Closely work with all BA's and stake holders for reviewing User Stories and scoping documents.
• Working with Carriers to gather their requirements and creating mapping documents and interpreting XML documents.
• Coordinate with Connecticut Health Exchange HIX program staff and other stakeholders to define and develop requirements for correspondence generation across various business lines.
• Practice agile methodology, lead sprints and prioritize line items based on key business initiatives with respect to the ACA mandate and Health Care Reform Act
• Gather requirements for correspondence and report generation from functional and business owners and convert these requirements into User Stories.
• Work closely with Health Rules developers to understand system specifications and formulate requirements to align with these specifications.
• Help develop integration solutions that create interoperability between Health Rules and HP Exstream.
• Devise workarounds make recommendations and modify procedures to solve intricate problems considering system capacity and limitations, operating time, and desired business results.
• Maintained a requirement traceability matrix throughout the project.
• Track user stories, tasks, burn down hours and project progress in Version 1 for correspondence and reports efforts across various work streams, participate in daily scrum meetings, provide status reports, impediments and milestones to scrum masters to meet tight project deadlines. Raise issues and escalations in IRAAD as possible threats to project deadlines.
• Followed the UML based methods using Rational rose to create use cases, activity diagram, sequence diagram, collaboration diagram that include functional and non-functional specifications to hand off to development teams Lead Member Experience Review Boards to gather a user experience perspective on content, usability and readability of correspondences. Liaison closely with content writers to align the content to specific and unique business needs.
• Work with Quality Assurance team to validate system acceptance and user acceptance test plan and test scripts.

Environment: HP Exstream, Health Rules, XML, Agile- Scrum, Version One, MS Visio, MS-Word, Excel, Power Point.

Confidential

Sr. Business System Analyst

Responsibilities:

• Knowledge of the complete EDI format used in electronic documentation which was part of the knowledge transfer program to the vendors as per the requirements.
• Performed Gap analysis pertaining to 4010 5010 conversion to accommodate the ICD-10-CM and ICD-10-PCS code sets.
• Involved in associating ICD 10 code sets to CPT, HCPCS code sets and modifiers.
• Assisted with building the EDI 837, 835, 270/271, 276/277, 278, 820 and 834 transactions processing flow from the Trading Partners to the translator.
• Actively participated in the designing of the EDI transactions using the new HIPAA 5010 version also including the use of ICD-10 codes.
• Gathered User Requirements and Business Requirements to create the Business Requirement Documentation BRDs , Functional Requirement Documents FRDs using MS Word and MS Visio that provided scope of work for technical team to develop prototype and overall system.
• Prioritized requirements, developed business scenarios to check how the system would work with the roles and processes of the departments, and developed acceptance criteria.
• Conducted AS-IS and TO-BE analysis and assisted in developing process models and systems integration structure.
• Developed Use cases, Use case models, Activity models, sequence diagrams and other UMLs to better understand the functioning and desirability of the application.
• Conducted and facilitated Joint Application Development JAD sessions to reduce time spent in moving information between stakeholders and team members.
• Wrote Test Cases and Test Plans for the related and assigned scripts according to the test strategies defined in the project and testing team guidelines in Quality center.
• Tracked and maintained Stakeholder requested enhancements and changes using Requirement Traceability Matrix RTM .
• Worked with risk management team and identified and analyzed different critical areas of business and the risk involved and then modified business processes to reduce risk.
• Worked with Source system Subject Matter Expert SME to ensure that the extracts are properly mapped. Used SQL for data mapping and querying.
• Performed SWOT and Gap analysis for the new functionality requirements by identifying existing technologies, documenting the enhancements to meet the end state requirements.
• Conducted various types of internal Audits including Financial and other systems audits.

Environment: MS Office, Quality Center, SQL Server, Facets 4.21, MS Project, Server, MS Visio, Unix, J2ee, Java, XML, Mainframes and Rational ClearQuest, ClearCase, Windows XP

Confidential

Sr. Business System Analyst

Responsibilities:

• Responsible for the full HIPAA compliance lifecycle from gap analysis, mapping, implementation and testing for Medicaid Claims.
• Conducted user interviews, gathered requirements, analyzed and documented business requirements in BRD and TRD.
• Coordinated with the stakeholders and project key personnel to gather functional and non-functional requirements during JAD sessions.
• Studied the existing business process and created AS-IS workflow to illustrate the existing system.
• Propose strategies to implement changes in the old Medicaid MMIS system eventually move to new MMIS with HIPAA 5010.
• Responsible for Medicaid Claims Resolution/Reimbursement for state health plans using MMIS.
• Served as a liaison between the internal and external business community Claims, Billing, Membership, Capitation, Customer service, membership management, provider management, advanced Healthcare management, provider agreement management and the project team.
• Created 837 P, I, D claims, and maintained data mapping documents in reference to HIPAA transactions primarily 837 P, I, D , 835, 270/271, 276/277 and 278.
• Actively analyzed current business processes Claims, Recipient eligibility and enrollment etc. and worked with management to improve and implement enterprise solutions to ensure compliance.
• Responsible for creating business work flows and processes and creating management reports based on the analysis.
• Followed the UML based methods using Rational rose to create use cases, activity diagram, sequence diagram, collaboration diagram that include functional and non-functional specifications to hand off to development teams.
• Participated in developing test plan, test scripts, and test scenarios and designed user documentation.
• Actively involved in updating internal processes submit claims, check eligibility , updating data collection and data reporting.

Environment: MS Project, Rational tools, MS Word, SharePoint, Visio, SQL, and MS Excel

Confidential

Business Analyst

Responsibilities:

• Conducted JAD sessions with all stakeholders including development team/technical team to drive out detailed business requirements for the Claim Processing system.
• Was involved in requirements gathering, identifying and preparing Use Cases, creating Traceability matrix and tagging it in the Rational Requisite Pro.
• Prepared the BRD Business Requirement document , FRD Functional requirement document UCN Use case narrative , for transaction sets 837, Inbound-Professional, institutional, dental claims , 835 Outbound transactions , 270/271 Eligibility Request and Response , 277CA Health Care Claim Acknowledgement as per the requirements.
• Prepared the Process flows, Flowcharts and Information Value Chain for the Current state for all the transactions across all channels.
• Implemented Agile Methodology to process, standards and procedures.
• Created parsing methodology process for EDI files to convert data elements into Class objects and its properties.
• Performed performance testing for no size limitation of EDI files.
• Documented risk analysis of the requirements to identify the key business risks areas for the project and prioritized the application development and testing.
• Implemented system functionality through UML artifacts such as use cases, use diagrams and process charts.
• Developed test cases, creating test scripts, analyzing bugs, and assisted with Quality assurance and development teams in defect management and User Acceptance Testing UAT
• Performed SQL queries by executing Procedures, triggers to perform backend testing in database.
• Assisted with Testing and Certification of EDI transactions as per HIPAA guidelines to help ensure transactions are compliant with standards, and requirements

Environment: MS Visio, Word, Excel, PowerPoint, CMMI, Rational Rose, Requisite Pro, Clear Case, Clear Quest, SQL, Oracle, J2EE technology, Java, Perl.

Confidential

Position: Business Analyst/Tester

Responsibilities:

• Prepared test cases/test scripts based on use cases, functional specs and requirements and design documents.
• Extensive interactions with the client and the management teams to understand the requirements and report the status of the testing efforts on their applications.
• Documented Test cases, test results, test procedure and reported to QA Manager and Developers.
• Involved in Complete SDLC Software Development Life Cycle .
• Identified, researched, investigated, and documented business processes and Use Case Scenarios.
• Conducted workflow, process diagram and gap analysis to derive requirements for existing systems enhancements
• Assisted with user testing of systems UAT , with developing and maintaining quality procedures, and with ensuring that appropriate documentation was in place.
• Undertook responsibilities for identifying and documenting business rules and creating detailed Use Case and Conducted User Acceptance Testing.
• Defining, Presenting and Documenting Test Plans and Test Strategies for each release of the application.
• Worked with development and testing teams to accomplish timely release objectives. Used detailed knowledge of application features and functions to assess the scope and impact of business needs throughout analysis.
• Extensively worked, prepared and presented project documentations.
• Extensively worked on Access, Excel, Word and PowerPoint.
• Created the detailed test plan and test cases from the business requirements document and meetings with the business managers.
• Involved in compatibility testing, integration testing and User Acceptance testing UAT .
• Determined test approaches for various testing strategies like Functional, System, Regression, UI, UAT, Usability testing, Alpha, Beta testing and executed using Win Runner.
• Conducted data Driven tests in Win Runner by parameterization, worked with the data table, modified the script for data-driving, and wrote SQL statement in Script to retrieve data from database.
• Regularly following up with Development Team to discuss discrepancies identified during testing and performance tuning.
• Responsible for weekly status to show the Progress of the automation testing effort.

Environment: J2EE, Win Runner, Rational Clear Quest, Clear case, Web logic, SQL, UNIX, Microsoft Word, Microsoft Excel, Microsoft PowerPoint

Confidential

Business Analyst

Responsibilities:

• Created business process workflow diagrams Activity diagrams in Rational Rose.
• Creating test plans utilizing the customer request documents for identifying specific business requirements to be created and maintained numerous automated functional regression tests from the ground up and delivered on time working within an Agile SCRUM process.
• Gathered user and business requirements through discussions, brainstorming, interacting with corporate to understand the business requirement
• Worked with the business users to define business requirements and analyze the possible technical solutions.
• Functioned effortlessly and efficiently, as a liaison between four work streams and its task leads, SMEs, QA team, and management group. Actively participated in Joint Meetings with the various teams involved in the development process.
• Implementing Software Quality Assurance SQA development policies, procedures, SDLC and testing methodologies.
• Facilitated JAD and JRP sessions with management, development team, users and other stakeholders to refine functional requirements.
• Performed extensive data analysis and data integrity testing for loading and validation of the data set output.
• Worked on analysis, design and testing of scheme implementation for the Financial Data Mart implementation.
• Reviewed the user perspective use cases to determine the functionality that had been incorporated on the web application.
• Reviewed the test cases that detailed the functionality to be tested in various UIs.
• Performed the User Acceptance Testing of the functionality and involved in defect management process using Track Record TR .
• Interacted with the SME's and stakeholders to get a better understanding of client business processes and gather business requirements.
• Redefined existing Business Processes and preparing To-Be Processes using MS Visio.
• Developed Traceability Matrix for maintaining/updating current and new system requirements using MS Excel.
• Created and managed Use Case project templates.

Environment: JAD, MS Visio, Windows 2000/2003,RUP, Rational RequisitePro, Rational Rose, Oracle , SQL, PL/SQL, MS Office, Load Runner, UAT.